Lower Ince Surgery

Updated 20 September 2017

Lower Ince Surgery has 4,000 registered patients and is part of, and managed by the SSP Health Group of Practices and has recently re-registered as a provider of Personal Medical Services. The practice mainly consists of a white British population with high levels of social deprivation. It is overseen by Wigan Borough Clinical Commissioning Group (CCG).

The surgery is located in Clare House which is a community building holding other GP practice, out of hours’ services, a community older people’s mental health team, children’s nursing team and a pharmacy. Lower Ince is situated on the ground floor which is fully accessible to people with mobility difficulties. There is ample car parking spaces for abled and disabled people.

The practice also provides a range of enhanced services such as minor surgery (at another location) rotavirus and shingles immunisations, ECG monitoring and ultrasound scanning (at another location). Travel immunisations included yellow fever are also offered.

There are four regular GPs (three male and one female) at the practice, supported by the extended clinicians within the SSP organisation. In addition, there is a regular practice nurse and a health care assistant working part time, supported by extended nursing staff (including an advanced nurse practitioner) within the SSP organisation.

The practice opening times are as follows :-

Monday 8am to 6.30pm

Tuesday 7am to 6.30pm

Wednesday 7am to 6.30pm

Thursday 8am to 6.30pm

Friday 8am to 6.30pm

Appointments are available at various times throughout the day and a telephone consultation service is available on a daily basis. Patients requiring a GP outside of normal working hours have access to the Wigan Hub and a walk in facility, where no appointment is required and is based at Leigh Walk in Centre.

This practice has been accredited as a GP Training Practice and can have one or more qualified junior GPs training to specialist in General Practice.

Updated 20 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lower Ince Surgery on 31 July 2017. Overall, the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
• The practice had clearly defined and embedded systems to minimise risks to patient safety.
• Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
• Results from the most recent national GP patient survey showed patients were mostly satisfied with the surgery and felt involved in their care and decisions about their treatment.
• Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients we spoke with said they were able to make an appointment with a named GP if required and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs.
• There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted upon. Staff were able to work flexibly and across different SSP locations.
• The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
• The practice had a proactive patient participation group (PPG).

We saw an area of outstanding practice :

The practice had a successful Hypnotic Reduction Programme of patients on Benzodiazepine Medicines. (Benzodiazepines are a group of medicines sometimes used in patients with anxiety, sleeping problems and other mental health disorders).  Before SSP Health were awarded the contract, Lower Ince Surgery was the highest prescriber of this medicine in the country. The improvement had been achieved through an in-house reduction programme devised by the provider in agreement with patients who fitted the criteria.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 20 September 2017

The practice is rated as good for the care of people with long-term conditions.

• There was a methodical system to ensure patients received annual reviews.This included the important patient register.

• Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. Planned home visits coincided with flu/pneumococcal immunisations.

• The percentage of patients with diabetes receiving the required interventions was 100% and clinical exception reporting was 6% which was 2% lower than the local and national average.(Exception reporting is where patients are disregarded for reporting purposes after specific criteria had been met).

• There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

• All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care.

• Longer appointments, up to 45 minutes, were available for patients with multiple conditions for their convenience and to ensure time was available for a more holistic review of their care needs.

• A carer, palliative care and bereavement champion maintained a register of patients with long-term conditions and cancer and provided them with information about local community and practice support services.

Updated 20 September 2017

The practice is rated as good for the care of families, children and young people.

• The practice sent a congratulations letter to all new parents.

• From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk.For example, children and young people who had a high number of accident and emergency (A&E) attendances.

• Staff attended regular safeguarding meetings where they were updated on the safeguarding issues within practice.

• Immunisation rates were relatively high for all standard childhood immunisations.

• The premises were suitable for children and babies. For example, breast feeding and changing facilities were available.

• Appointments outside of school hours were available.

• An Early Years fact sheet was sent to new parents providing information about vaccination schedules, breast-feeding, cervical screening and other health related information to support and promote health and wellbeing.This factsheet was available in different languages to support patients whose first language was not English.

• Same day appointments were available for children to reduce potential anxiety for parents and reduce the need to access accident and emergency and out of hours’ services.

• Weekly and ad-hoc baby immunisation clinics and eight week baby checks were available.

• The practice offered advice on contraception and sexual health and took part in the National campaign “RU Clear” for sexually transmitted diseases.

Updated 20 September 2017

The practice is rated as good for the care of older people.

• Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

• The practice offered proactive, personalised care to meet the needs of the older patients in its population. Nursing staff visited patients at home if they were unable to attend the practice to manage chronic disease and long term conditions.

• The practice was responsive to the needs of older patients and offered home visits and urgent appointments for those with enhanced needs.

• The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs. Where older patients had complex needs, the practice reviewed their treatment plans regularly.

• Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, regular coffee mornings were held at the surgery to encourage patients to meet up in order to reduce social isolation.

• There was a dedicated carers’ champion who maintained a register of these patients and signposted them to community support services.

Updated 20 September 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

• The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.For example, providing health care information in different languages and holding charity events.

• The practice was proactive in offering online services as well as a full range of health promotion and patient screening that reflected the needs for this age group.

• The practice offered a health check to all registered patients and NHS Health checks every five years for those patients between the ages of 40 – 74 years of age.

• Appointments and repeat prescriptions could be booked online.Telephone appointments were available daily with the nurse and GPs.

• Patients were able to use the ‘Text to Cancel’ service allowing patients to cancel unwanted appointments.This improved access to appointments for other patients and reduced the rate of missed appointments.

• Minor surgery injections were offered at another location.

• The practice worked with local pharmacies to ensure patients could use a pharmacy of their choice for ordering and collection of medicines.

Updated 20 September 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• The practice carried out advance care planning for patients living with dementia.

• The practice considered the physical health needs of patients with poor mental health and dementia.

• The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive care plan agreed with them or their family was 95% which was 15% above the CCG average and the national average.

• The practice had a superior system for monitoring and controlling repeat prescribing for patients receiving medicines for mental health needs specifically high risk medicines.

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

• Patients at risk of dementia were identified and offered an assessment.

• The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

• The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Opportunistic screening of patients physical health care was discussed and provided to patients during pre-booked appointments

Updated 20 September 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of important patients which included patients living in vulnerable circumstances.

• End of life care was delivered in a coordinated way that took into account the needs of those whose circumstances may make them vulnerable.

• The practice offered longer appointments for patients with a learning disability and mental health problems so they had more time to discuss their health care issues.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

• Staff we spoke with knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They understood their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

• All staff were trained in safeguarding.The IT system alerted staff to patients subject to safeguarding.

• Regular safeguarding meetings and review of patients on the important patient register took place to ensure those patients received the support and medical treatments they needed.

• Staff were trained to act as chaperones.

• The practice was accredited by the LGBT Foundation for its services provided to LGBT patients.

• Wheelchair access was available and leaflets were printed in large font for patients who were partially sighted.

• Health promotion materials were available in a range of different languages and a language interpretation service was used.